Short-term disability insurance provides coverage for certain qualifying disabilities, including pregnancy. It is meant to replace a portion of your paycheck until you recover from the disability and can return to work.[1] If you are denied coverage, then you will probably appeal by submitting an appeal letter along with supporting documentation. Your appeal letter can be simple. It generally should explain why you qualify as disabled under your plan’s definition.

Part 1

Building Your Case

Sometimes you might be rejected because you provided insufficient information.

Alternately, you could be rejected because the policy doesn’t cover your disability.

2

Identify how to appeal. The denial letter should also tell you how to appeal and provide any deadlines that you must meet. Highlight this information and write down deadlines on your calendar so that you don’t forget.

If the information is not in the letter, then call up the insurance company immediately.[3]

3

Request a copy of your claim file and other documents. If you get short-term disability through an employer, then you have a right to request a copy of your claim file, summary plan description, and your policy. The plan administrator must provide you with these documents within 30 days.[4]

Send a note requesting these documents to the plan administrator, who may be either your employer or the insurance company.

Gather supporting documentation. If you were rejected because you provided insufficient information, then you need to gather that supporting documentation. You will want to provide this supporting documentation along with your appeal letter. For example, you might want to get the following:[5]

medical records from your doctor

an opinion from your doctor or from a second doctor

written observations by coworkers or your boss about how the injury has affected you

other records, such as police records if you were injured in an accident

5

Consider a lawyer’s help. You might not know how to begin appealing. If so, you could think about meeting with a lawyer.[6] However, you need to be aware that lawyers don’t work for free, so the expense could outweigh the amount of short-term disability benefits you are seeking.[7] However, try to find low-cost legal help in the following places:

If you are low income, then you might qualify for legal aid. Legal aid provides low cost or free legal help to people with incomes less than 125% of the federal poverty level. You can find legal aid by visiting http://www.lsc.gov.

You also could meet with a lawyer for a half-hour of advice. You could show the lawyer your letter and ask for tips on improving it. A lawyer might charge $400 an hour but charge $200 for a half-hour of advice. You can get a referral to a lawyer by contacting your local or state bar association.

Part 2

Sending Your Appeal Letter

1

Format the letter. You should set up the letter like a standard business letter. Double space the document and set the font to something readable. Usually, Times New Roman 12 point is acceptable.[8]

2

Provide necessary information. The insurer should be able to identify who you are and why you are appealing from reading your letter. Accordingly, make sure to provide the following information:[9]

your name

your policy number or identification number

reason the insurer denied your claim

brief description of your disability

3

Explain why the insurer should grant you benefits. You also should explicitly ask the insurer to change its mind. Be sure to mention your supporting documentation and argue that these documents show you qualify for benefits.[10]

For example, you could write, “As my enclosed medical records show, I broke my arm on August 15, 2016. Because my job requires that I shelve books and boxes above my head, I have been unable to complete a shift since August 16. My enclosed letters from two coworkers explain the details of our job and how I had to leave early two times because I could not complete tasks. I have been out of work since. For these reasons, I am asking that you approve my request for short-term disability benefits.”

4

Include your supporting documentation. Make copies of whatever documents you are including—medical records, notes from coworkers, etc. Don’t send originals. You can also include a copy of your application and the original denial letter.[11]

5

Submit the appeal letter. Make a copy of the letter for your own records, and then send it certified mail, return receipt requested to the address provided by the insurance company.[12] Hold onto the receipt.

6

Wait for a response. The insurance company should review your appeal letter and supporting documentation. You should receive a response in writing.

You should also consider other appeals. The letter might tell you that you can bring an additional appeal and how. If your short-term disability insurance is sponsored by your employer, then you can continue to appeal. First, you would appeal to an administrative judge and then you might file a lawsuit in federal court.[13]